- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,291.67 / $1,291.67 / $1,291.67
| Facility | | $1,291.67 | $1,291.67 | $1,291.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.76 / $2,401.69 / $10,887.23
| Facility | | $1,106.76 | $2,401.69 | $10,887.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,029.82 / $4,728.77 / $11,375.69
| Facility | | $3,029.82 | $4,728.77 | $11,375.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,625.61 / $4,315.31 / $8,957.24
| Facility | | $2,625.61 | $4,315.31 | $8,957.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,250.41 / $2,182.92 / $3,988.61
| Facility | | $1,250.41 | $2,182.92 | $3,988.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.00 / $3,500.00 / $8,152.00
| Facility | | $796.00 | $3,500.00 | $8,152.00 |